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Client/Proiect Name. f"-5 F:R- 0 VO - 1 7 - , t- GLOP-kW <br />Analysis (Check all applicable) <br />P.O /Project Number: licsa... AA 7. kit <br />Rill <br />MEM <br />1111111 <br />E <br />III <br />Ell <br />NM <br />11111 <br />1 <br />_fie4 <br />Contact. ( - R. ' <br />Address 2.74.4(, U..) S' Atit. kit)GAA Co t IIM <br />Phone 4 136 V. <br />4 75 9C) <br />E Ma i 1: T RipP 1..)FC ilOci.Ar0 <br />Sampler: 1 <br />Fax if 1 -4 zii,s- <br />_.---- -Pal- AX <br />Report By' 1111 Mall <br />Sample Location or ID <br />Date <br />7. 2-1. f L <br />Time <br />(d 4b <br />Gr ab/ <br />Comp <br />C <br />Lab ICI <br />LAI Usg,7 <br />7,1-23.77,2 , 1 <br />e Ni - - • ;,2i r 3 <br />IIIIIII <br />111 <br />11111 <br />FA <br />--, al,e,, <br />RIM <br />III <br />NNE <br />111111111 <br />EMI <br />, <br />.111111111, <br />III Ell <br />•r. <br />5. <br />Tur naround Requirements <br />iltsnahiiraliestirutOrM <br />Test Species:Ararghead riiiinnoveriodaphnia Daphnia magna D Daphnia pulex Dother (List Relo <br />Standard (10 <br />days) <br />6-9 Day <br />1 2 Day <br />Special Instructions/Comments: <br />Requested Kew!, Eate. <br />Relinquished By (1) <br />Received By (1) <br />Relinquished Dy (2) <br />. Received By (2) <br />S.gnature <br />Darc4firne <br />Sg fp ratp/Tini a <br />' ,•'' <br />57 <br />040.1Timu <br />Signature <br />DagPiTime <br />149.creitqfPlIP <br />CHAIN OF CUSTODY <br />1341 Cannon Street - Louisville, CO 8002/ <br />(303) 661.9324 - FAX 303) 661.932.5 <br />